Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 24, 2016; 6(2): 347-355
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.347
Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality
José M Borro, María Delgado, Elisabeth Coll, Salvador Pita
José M Borro, María Delgado, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, 15006 Corunna, Spain
Elisabeth Coll, Organización Nacional de Trasplantes ONT, 28029 Madrid, Spain
Salvador Pita, Clinical Epidemiology, Corunna University Hospital, 15006 Corunna, Spain
Author contributions: All authors contributed equally to design, case retrieval and analysis; Borro JM drafted the manuscript; all authors reviewed it and contributed to the final approved version.
Institutional review board statement: This study was approved by the institutional review board of Galicia (Registre code 2012/235).
Informed consent statement: Patients were required to give informed consent to the study.
Conflict-of-interest statement: We have no financial relationships or conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: José M Borro, MD, Department of Thoracic Surgery and Lung Transplantation, Corunna University Hospital, Xubias de Arriba 84, 15006 Corunna, Spain. jose.ma.borro.mate@sergas.es
Telephone: +34-98-1178187 Fax: +34-98-1178235
Received: November 28, 2015
Peer-review started: November 30, 2015
First decision: December 28, 2015
Revised: January 31, 2016
Accepted: March 9, 2016
Article in press: March 14, 2016
Published online: June 24, 2016
Processing time: 207 Days and 9.2 Hours
Abstract

AIM: To performed remains a subject of debate and is the principal aim of the study.

METHODS: This retrospective analysis included 73 patients with emphysema (2000-2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT).

RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial respiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival (P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained (n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted (P = 0.875).

CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.

Keywords: Lung transplantation; Single-lung; Survival; Complications; Emphysema; Double-lung

Core tip: This is a retrospective and comparative study of 2 cohort of patients with advanced-stage emphysema who were performed uni or bilateral lung transplant. The results of this study support the realization of single-lung transplantation in most of the cases of emphysema because it is technically simpler, it has less risk of surgical sutures, and finally it has less immediate postoperative complications. Single and double lung transplantation has a similar long-term survival. Moreover, if a second transplant is needed in the long-term, the contralateral transplantation has the same initial transplant survival if the patient remains in a similar clinical situation. Survival Spanish national register does not show difference between the two techniques too, supporting the results of our relatively small series. This strategy of performing single lung transplantation in most of the cases of emphysema would encourage and enhance the use of donors thanks to the twining procedure, and would decrease mortality in the waiting list as shown in the National Transplant Organization patients analysed. Proper pre and postoperative prophylaxis and postoperative early extubation protocol is essential to achieve good results.